老年特发性血小板减少性紫癜患者的临床观察

Clinical study on the elderly patients with idiopathic/immune thrombocytopenic purpura

目的总结老年特发性血小板减少性紫癜（ITP）患者的发病特点、治疗及临床转归。方法回顾分析1992-2007年我院住院治疗的老年ITP患者的临床资料，并与同期住院的非老年患者的临床资料进行对照。结果老年患者（老年组）43例，男性16例，女性27例；随访时间1个月～15年，存活35例。43例患者中，7例血小板持续（30～50）×10^9／L，出血不显著，未予以治疗；36例首选泼尼松治疗，敏感型25例（69．4％），以完全反应或部分反应健康存活；脾切除或栓塞4例，3例血小板恢复正常；对于泼尼松治疗不敏感者分别使用免疫抑制剂，其中硫唑嘌呤21例，环孢A23例，长春新碱3例及环磷酰胺9例，硫唑嘌呤、环孢A疗效优于长春新碱及环磷酰胺。进展为难治性ITP5例，难治率为13．9％；进展为未定性单克隆免疫球蛋白增多症（MGUS）和淋巴瘤各1例。死亡8例，死于外伤感染引发的心肺功能衰竭4例，肿瘤3例，脑出血1例。结论老年ITP患者临床表现不典型，致命性出血的风险低，对免疫抑制剂的反应与非老年组近似，治疗宜个体化。

Objective To explore the clinical characteristics, therapy reactions and prognosis of the elderly patients with idiopathic thrombocytopenic purpura （ITP） . Methods A total of 43 elderly ITP patients （age≥60 years old） including 16 men and 27 women were reviewed and further followed up for 1 month to 15 years. Results Until June 2007, 35 elderly ITP patients survived, platelet counts were sustained （30-50）×10^9/L in 7 cases, but no significant bleeding was found. Thirty-six patients had adrenocorticosteroid therapy first, 25 patients were sensitive to adrenocorticosteroid therapy, 4 patients underwent splenectomy, and 3 patients achieved a normal platelet count. Immunosuppressive agents （vinscristine, cyclophosphamide, azathioprine and Cyclosporin A） treatments were held in 56 case-times, Cyclosporin A and azathioprine were more effective than vinscristine and cyclophosphamide. The refractory rate was 13. 9%. One patient progressed to monoclonal gammopathy of unknown significance and 1 to lymphoma. Eight patients died, 1 patient died of brain bleeding after trauma, 3 patients died of malignant neoplasm, 4 patients died of heart failure induced by infection. Conclusions The clinical features of elderly ITP patients are atypical, the mortal bleeding in them was rare, treatment strategy should be individualized to each elderly patient .